The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.).
Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH (M.E.).
Circ Cardiovasc Interv. 2024 Jul;17(7):e013729. doi: 10.1161/CIRCINTERVENTIONS.123.013729. Epub 2024 Apr 26.
Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction.
This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed.
Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (=0.018), body surface area (=0.013), and minimum-to-descending aortic diameter ratio (<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio.
Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.
经皮主动脉弓支架植入术为治疗主动脉弓阻塞提供了一种重要的替代疗法，而主动脉弓阻塞是一种具有挑战性的病变。本研究旨在评估经皮主动脉弓支架植入术治疗主动脉弓阻塞的技术、程序和中远期临床疗效。
这是一项回顾性、多中心的主动脉弓支架植入术研究。进行了单变量和多变量分析。
共有 146 例患者接受了 187 次支架植入术。患者的中位年龄为 14.3 岁（四分位距：9.3-19），体重为 53kg（30-69kg），随访时间为 53 个月（12-120 个月）。最常见的支架设计是开孔细胞支架（n=90，48%）。在 118 例（81%）患者中，支架覆盖了 142 个弓状血管（37 个颈动脉）。技术和程序成功率分别为 100%和 88%。体重（P=0.018）、体表面积（P=0.013）和最小降主动脉直径比（P<0.001）越低，基线主动脉梯度越高。残余梯度与植入和最终扩张直径呈反比（P<0.001）。主动脉损伤和支架相关并发症的总发生率为 14%。没有异常的脑部扫描或中风报告。1 年随访时，血压袖带梯度、超声心动图弓状速度和高血压发生率随着降压药物使用量的增加而改善。首次介入后中位时间 84 个月（22-148 个月）内，60 例（41%）患者进行了 60 次再介入治疗。多变量逻辑回归分析显示，在控制每个最终扩张直径、体重和最小降主动脉直径比的情况下，残余主动脉梯度>10mmHg 与所有时间点的再介入几率增加相关。
经皮主动脉弓支架植入术具有较高的技术、程序和中远期临床成功率。残余主动脉梯度>10mmHg 与 1 年和最近随访时再介入几率增加相关。开孔细胞支架设计因其顺应性好、弓状血管灌注良好、断裂率低以及能够有效进行侧孔血管成形术等优点而被广泛应用。
